Disparate resource allocation during the COVID-19 pandemic among trauma centers: A Western Trauma Association national survey


  • The COVID-19 pandemic has strained healthcare systems and physicians alike, this was evident early on as seen by the data over physician health and burnout in this survey.

  • Trauma and Acute Care Surgeons faced multiple frustrations at the beginning of the pandemic to include administrative communication and resources availability.

  • Lack of standardization of resource allocation was evident early-on.

  • Opportunities remain to coordinate best-practice planning and implementation for future pandemics.



During the pandemic, hospitals implemented disaster plans to conserve resources while maintaining patient care. It was unclear how these plans impacted injury care and trauma surgeons.

Study design

A 16 question survey assessing COVID-related hospital policy and resource allocation pre-COVID-19 peak (March), and a 19 question post-peak (June) survey was distributed to Trauma/Critical Care attending’s via social media and the Western Trauma Association member email list.


There were 120 pre- and 134 post-peak respondents. Most (95%) altered trauma PPE components, a nd 67% noted changes in their admission population pre-peak while 80% did so post-peak. Penetrating injury increased 56% at Level 1 centers and 27% at Level 2 centers. Altered ICU and transfusion criteria were noted with 25% relocating TBI patients, 17% revised rib fracture admission criteria, and 23% adjusted transfusion practices. Importantly, 12% changed their massive transfusion protocols, with 11% reducing the symptomatic transfusion threshold from 7g/dL to 6g/dL. Half (50%) disclosed impediments to patient care including PPE shortages and COVID test-related procedural delay (Fig. 2). While only 14% felt their institution was overwhelmed by COVID, the vast majority (81%) shared durable concerns about personal health and safety.


Disparate approaches to COVID-19 preparedness and response characterize survey respondent facility actions. These disparities, especially between Level 1 and Level 2 centers, represent opportunities for the trauma community to coordinate best-practice planning and implementation in light of future consequence infection or pandemic care.


1. Introduction

Widespread international travel enables the global spread of high-consequence infections such Severe Acute Respiratory Syndrome (SARS) SARS-CoV-2. Outbreaks such as SARS, the Middle Eastern Respiratory Syndrome (MERS), and the novel influenza A subtype H1N1 have triggered worldwide public health emergencies and exposed gaps in our healthcare, economic and political systems. Each crisis has refined disaster protocols and augmented disaster preparedness.

  • Franco-Paredes C.
  • Carrasco P.
  • Preciado J.I.
The first influenza pandemic in the new millennium: lessons learned hitherto for current control efforts and overall pandemic preparedness.